Caregiver decisions along the Alzheimer's disease trajectory.

Despite the rising prevalence of Alzheimer's disease (AD), there is limited systematic evidence about disease specific decisions. The aim of this qualitative descriptive study was to identify decisions across the AD trajectory using focus groups of past and present caregivers. Qualitative content analysis revealed three main categories with corresponding categories and sub-categories. Main Category One-Decisions pertaining to self-yielded two categories: decision pertaining to the offering of self and care for the caregiver. Main Category Two-Decisions pertaining to the patient-yielded three categories: decisions about care and treatment, living arrangements, and protecting the patient from harm. Main Category Three-Communication and relationships in decisions-yielded two categories: navigation and negotiations. The results of this study will inform healthcare providers and caregivers as they work together to anticipate, prepare, and plan for care management decisions over the AD trajectory.

Advance care planning and anticipatory decision making in patients with Alzheimer disease.

Early advance care planning and anticipatory decision making in the Alzheimer disease (AD) trajectory is a strategy NPs can incorporate to improve managing uncertainty around common decisions. This article explores decisions patients and caregivers face along the AD trajectory and provides resources for patients, caregivers, and NPs.

Shared Decision-Making for Nursing Practice: An Integrative Review.

BACKGROUND: Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. OBJECTIVE: To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. METHODS: An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. RESULTS: Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. CONCLUSION: A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.

Effectiveness of sleep education programs to improve sleep hygiene and/or sleep quality in college students: a systematic review.

BACKGROUND: Sleep health is essential for overall health, quality of life and safety. Researchers have found a reduction in the average hours of sleep among college students. Poor sleep has been associated with deficits in attention, reduction in academic performance, impaired driving, risk-taking behaviors, depression, impaired social relationships and poorer health. College students may have limited knowledge about sleep hygiene and the behaviors that supports sleep health, which may lead to poor sleep hygiene behavior. OBJECTIVES: To identify, appraise and synthesize the best available evidence on the effectiveness of sleep education programs in improving sleep hygiene knowledge, sleep hygiene behavior and/or sleep quality versus traditional strategies. INCLUSION CRITERIA TYPES OF PARTICIPANTS: All undergraduate or graduate college students, male or female, 18 years and older and of any culture or ethnicity. TYPES OF INTERVENTIONS: Formal sleep education programs that included a curriculum on sleep hygiene behavior. Educational delivery methods that took place throughout the participants' college experience and included a variety of delivery methods. TYPES OF STUDIES: Randomized controlled trials (RCTs) and quasi-experimental studies. OUTCOMES: Sleep hygiene knowledge, sleep hygiene behavior and/or sleep quality. SEARCH STRATEGY: Literature including published and unpublished studies in the English language from January 1, 1980 through August 17, 2015. A search of CINAHL, CENTRAL, EMBASE, Academic Search Complete, PsychINFO, Healthsource: Nursing/Academic edition, ProQuest Central, PubMed and ERIC were conducted using identified keywords and indexed terms. A gray literature search was also performed. METHODOLOGICAL QUALITY: Quantitative papers were assessed by two reviewers using critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Data were extracted using the JBI-MAStARI data extraction tool. Data extracted included interventions, populations, study methods and outcomes of significance to the review question and objectives. DATA SYNTHESIS: Meta-analysis was not possible due to limited studies and variability of design and interventions; therefore, results are presented in narrative form. RESULTS: This systematic review yielded three RCTs and one quasi-experimental study for inclusion. Two studies reported outcomes on sleep hygiene knowledge; one showing a statistically significant improvement (P = 0.025) and the other reported no difference (test of significance not provided). Two studies reported on sleep hygiene behavior; one showing no difference (P > 0.05) and the other reporting a statistically significant improvement (P = 0.0001). Four studies reported on sleep quality; three reporting no difference (P > 0.05) and the other reporting a statistically significant improvement (P = 0.017). CONCLUSION: This reviewed article identified insufficient evidence to determine the effectiveness of sleep education on sleep hygiene knowledge, sleep hygiene behavior or sleep quality in this population.

The Patient Experience With Shared Decision Making: A Qualitative Descriptive Study.

Shared decision making is a process characterized by a partnership between a nurse and a patient. The existence of a relationship does not ensure shared decision making. Little is known about what nurses need to know and do for this experience to take place. A qualitative descriptive study was implemented using Coalizzi's method. Semistructured interviews were held with patients, and 3 themes were uncovered. The findings suggest that a nurse's conduct aimed at drawing patients in and inviting them to participate in a conversation leads toward shared decisions. Infusion nurses may find this information useful as they engage their patients in shared decisions.

Learning the faculty role: using the evolving case story of professor able in an online master of nursing education program.

This article presents the use of a case story about a fictitious character, Professor Able, as a strategy to learn about the role of the nurse educator and to assist in the transition from clinical practice into that role. The story evolves over a 13-week semester in an engaging, asynchronous online environment where students explore what it means to be a nurse educator. The story of Professor Able provides insights into faculty issues such as academic freedom, integrity, governance, and diversity. Students' online discussions highlight the interactive learning experience and outcomes generated by the use of the case story. This teaching strategy offers support for nurses transitioning into the much-needed role of nurse educator.

Shared decision-making in home-care from the nurse's perspective: sitting at the kitchen table--a qualitative descriptive study.

AIMS AND OBJECTIVES: To come to know, understand and describe the experience of shared decision-making in home-care from the nurse's perspective. BACKGROUND: The literature presents the concept of shared decision-making as a complex process characterised by a partnership between the healthcare provider and the patient, which is participatory and action oriented with education and negotiation leading to agreement. Few studies have been carried out to explore and describe the events that make up the experiences of shared decision-making in home-care from the nurse's perspective. DESIGN: A qualitative descriptive study was implemented. METHOD: Semi structured interviews were performed with 10 home-care nurses who were asked to reflect on a time in their practice when they were involved in a shared decision-making process with their patient. All data were analysed using Colaizzi's method. FINDINGS: The following Themes were uncovered: Begin where the patient is; Education for shared decision-making; The village and shared decision-making; and Whose decision is it? Each of the four Themes contained Subthemes. CONCLUSIONS: The findings of this study present shared decision-making as a complex, multidimensional and fluid process. A thorough understanding of shared decision-making is essential within the multiple contexts in which care is delivered. RELEVANCE TO CLINICAL PRACTICE: Nurses in clinical practice need to know and understand the events of the experience of shared decision-making. A more comprehensive understanding of these facts can assist home-care nurses in their practice with regard to the application of shared decision-making.

A qualitative systematic review of internal and external influences on shared decision-making in all health care settings.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify and synthesize the best available evidence related to the meaningfulness of internal and external influences on shared-decision making for adult patients and health care providers in all health care settings.The specific questions to be answered are: BACKGROUND: Patient-centered care is emphasized in today's healthcare arena. This emphasis is seen in the works of the International Alliance of Patients' Organizations (IAOP) who describe patient-centered healthcare as care that is aimed at addressing the needs and preferences of patients. The IAOP presents five principles which are foundational to the achievement of patient-centered healthcare: respect, choice, policy, access and support, as well as information. These five principles are further described as:Within the description of these five principles the idea of shared decision-making is clearly evident.The concept of shared decision-making began to appear in the literature in the 1990s. It is defined as a "process jointly shared by patients and their health care provider. It aims at helping patients play an active role in decisions concerning their health, which is the ultimate goal of patient-centered care." The details of the shared decision-making process are complex and consist of a series of steps including:Three overall representative decision-making models are noted in contemporary literature. These three models include: paternalistic, informed decision-making, and shared decision-making. The paternalistic model is an autocratic style of decision-making where the healthcare provider carries out the care from the perspective of knowing what is best for the patient and therefore makes all decisions. The informed decision-making model takes place as the information needed to make decisions is conveyed to the patient and the patient makes the decisions without the healthcare provider involvement. Finally, the shared decision-making model is representative of a sharing and a negotiation towards treatment decisions. Thus, these models represent a range with patient non-participation at one end of the continuum to informed decision making or a high level of patient power at the other end. Several shared decision-making models focus on the process of shared decision-making previously noted. A discussion of several process models follows below.Charles et al. depicts a process model of shared decision-making that identifies key characteristics that must be in evidence. The patient shares in the responsibility with the healthcare provider in this model. The key characteristics included:This model illustrates that there must be at least two individuals participating, however, family and friends may be involved in a variety of roles such as the collector of information, the interpreter of this information, coach, advisor, negotiator, and caretaker. This model also depicts the need to take steps to participate in the shared decision-making process. To take steps means that there is an agreement between and among all involved that shared decision-making is necessary and preferred. Research about patient preferences, however, offers divergent views. The link between patient preferences for shared decision-making and the actuality of shared decision-making in practice is not strong. Research concerning patients and patient preferences on shared decision-making points to variations depending on age, education, socio-economic status, culture, and diagnosis. Healthcare providers may also hold preferences for shared decision-making; however, research in this area is not as comprehensive as is patient focused research. Elwyn et al. explored the views of general practice providers on involving patients in decisions. Both positive and negative views were identified ranging from receptive, noting potential benefits, to concern for the unrealistic nature of participation and sharing in the decision-making process. An example of this potential difficulty, from a healthcare provider perspective, is identifying the potential conflict that may develop when a patient's preference is different from clinical practice guidelines. This is further exemplified in healthcare encounters when a situation may not yield itself to a clear answer but rather lies in a grey area. These situations are challenging for healthcare providers.The notion of information sharing as a prerequisite to shared decision-making offers insight into another process. The healthcare provider must provide the patient the information that they need to know and understand in order to even consider and participate in the shared decision-making process. This information may include the disease, potential treatments, consequences of those treatments, and any alternatives, which may include the decision to do nothing. Without knowing this information the patient will not be able to participate in the shared decision-making process. The complexity of this step is realized if one considers what the healthcare provider needs to know in order to first assess what the patient knows and does not know, the readiness of the patient to participate in this educational process and learn the information, as well as, the individual learning styles of the patient taking into consideration the patient's ideas, values, beliefs, education, culture, literacy, and age. Depending on the results of this assessment the health care provider then must communicate the information to the patient. This is also a complex process that must take into consideration the relationship, comfort level, and trust between the healthcare provider and the patient.Finally, the treatment decision is reached between both the healthcare provider and the patient. Charles et al. portrays shared decision-making as a process with the end product, the shared decision, as the outcome. This outcome may be a decision as to the agreement of a treatment decision, no agreement reached as to a treatment decision, and disagreement as to a treatment decision. Negotiation is a part of the process as the "test of a shared decision (as distinct from the decision-making process) is if both parties agree on the treatment option."Towle and Godolphin developed a process model that further exemplifies the role of the healthcare provider and the patient in the shared decision-making process as mutual partners with mutual responsibilities. The capacity to engage in this shared decision-making rests, therefore, on competencies including knowledge, skills, and abilities for both the healthcare provider and the patient. This mutual partnership and the corresponding competencies are presented for both the healthcare provider and the patient in this model. The competencies noted for the healthcare provider for shared decision making include:Patient competencies include:This model illustrates the shared decision-making process with emphasis on the role of the healthcare provider and the patient very similar to the prior model. This model, however, gives greater emphasis to the process of the co-participation of the healthcare provider and the patient. The co-participation depicts a mutual partnership with mutual responsibilities that can be seen as "reciprocal relationships of dialogue." For this to take place the relationship between and among the participants of the shared decision-making process is important along with other internal and external influences such as communication, trust, mutual respect, honesty, time, continuity, and commitment. Cultural, social, and age group differences; evidence; and team and family are considered within this model.Elwyn et al. presents yet another model that depicts the shared decision-making process; however, this model offers a view where the healthcare provider holds greater responsibility in this process. In this particular model the process focuses on the healthcare provider and the essential skills needed to engage the patient in shard decisions. The competencies outlined in this model include:The healthcare provider must demonstrate knowledge, competencies, and skills as a communicator. The skills for communication competency require the healthcare provider to be able to elicit the patient's thoughts and input regarding treatment management throughout the consultation. The healthcare provider must also demonstrate competencies in assessment skills beyond physical assessment that includes the ability to assess the patient's perceptions and readiness to participate. In addition, the healthcare provider must be able to assess the patient's readiness to learn the information that the patient needs to know in order to fully engage in the shared decision-making process, assess what the patient already knows, what the patient does not know, and whether or not the information that the patient knows is accurate. Once this assessment is completed the healthcare provider then must draw on his/her knowledge, competencies, and skills necessary to teach the patient what the patient needs to know to be informed. This facilitates the notion of the tailor-made information noted previously. The healthcare provider also requires competencies in how to check and evaluate the entire process to ensure that the patient does understand and accept with comfort not only the plan being negotiated but the entire process of sharing in decision-making. In addition to the above, there are further competencies such as competence in working with groups and teams, competencies in terms of cultural knowledge, competencies with regard to negotiation skills, as well as, competencies when faced with ethical challenges.Shared decision-making has been associated with autonomy, empowerment, and effectiveness and efficiency. Both patients and health care providers have noted improvement in relationships and improved interactions when shared decision-making is inevidence. Along with this improved relationship and interaction enhanced compliance is noted. Additional research points to patient satisfaction and enhanced quality of life. There is some evidence to suggest that shared decision-making does facilitate positive health outcomes.In today's healthcare environment there is greater emphasis on patient-centered care that exemplifies patient engagement, participation, partnership, and shared decision-making. Given the shift from the more autocratic delivery of care to the shared approach there is a need to more fully understand the what of shared decision-making as well as how shared decision-making takes place along with what internal and external influences may encourage, support, and facilitate the shared decision-making process. These influences are intervening variables that may be of significance for the successful development of practice-based strategies that may foster shared decision-making in practice. The purpose of this qualitative systematic review is to identify internal and external influences on shared decision-making in all health care settings.A preliminary search of the Joanna Briggs Library of Systematic Reviews, MEDLINE, CINAHL, and PROSPERO did not identify any previously conducted qualitative systematic reviews on the meaningfulness of internal and external influences on shared decision-making.

Partnership for healthy living: an action research project.

The purpose of this study was to develop and evaluate an advanced practice nurse case-management intervention programme in a US senior citizen community centre. Researchers Louise Gallagher, Marie Truglio-Londrigan and Rona Levin used a participatory action research method and found that a number of themes emerged to guide nursing interventions.

Second-career baccalaureate nursing students: a lived experience.

Second-career baccalaureate nursing programs and the students enrolled in them have been a topic of interest since these programs were first introduced into the academic setting in the 1970s. The purpose of this phenomenological inquiry was to develop an understanding of the meaning of the lived experience of being a second-career baccalaureate nursing student. Five second-career baccalaureate nursing students participated in unstructured, in-depth, face-to-face interviews. Data analysis was guided by the phenomenological method of van Manen. The themes identified were Questioning One's Place in the World; Seeing One's Place in the World in Another Way; Preparing for the Plunge; Trying Transitions; A Bundle of Emotions; Faculty Control, Student Imbalance; and Almost There and Scared. Implications of this research related to curriculum revision are presented.

Partnership model for practice and education.

The faculty practice partnership model provides a framework for collaboration between a practice setting and a university school of nursing. The model created between the Bergen County Department of Heath Services (BCDHS), the Office of Public Health Nursing (PHN) and Pace University's Lienhard School of Nursing (LSN) is one that supports faculty practice and student involvement in population-based activities. The partnership provides BCDHS with the assistance it needs to provide the three core functions of public health: assessment, assurance, and policy development. It provides LSN with a practice site where faculty members are able to maintain their clinical expertise, as well as a site for student clinical experiences and research. This article describes the partnership model and its accomplishments from both practice and educational perspectives.

Practice what you teach: a case study of ethical conduct in the academic setting.

Nursing faculty teach ethics and ethical behavior in undergraduate and graduate curriculum. In this article, a case study is presented that illustrates a breach of ethical behavior and conduct in the academic setting by both faculty and students. The decision-making process used to resolve this dilemma by the chair, the associate dean, and a faculty member relied on a dialectic approach that looked at philosophical underpinnings, historical background of nursing ethics, and university- and schoolwide policies and procedures. The conversations facilitated the ethical resolution to the dilemma raised in the case study as well as the recognition of additional issues for consideration. The authors uncovered compelling questions that included, "What is meant by ethical conduct in the classroom?," "How do we teach it?," and "How do we practice it?" The purpose of this article is to begin the dialogue in search of answers to these questions.

Evidence for smoking cessation: Implications for gender-specific strategies.

BACKGROUND: Facilitating smoking cessation requires an evidence-based approach. The Lienhard School of Nursing Institute for Healthy Aging in the United States, whose focus is providing health information to aging baby boomers, developed an interest in studying strategies for smoking cessation in women. APPROACH: Studies were reviewed and critiqued related to the question: What is the relative efficacy of first-line smoking cessation interventions for women versus men in the 40- to 65-year-old age group? This article first discusses the procedure used to construct an integrative framework for finding the evidence on smoking cessation, including a literature search and refinement of the problem to be studied, and then a summary of the evidence gathered on the selected variable (gender) and interventions (counseling, pharmacotherapy, nicotine replacement therapy). FINDINGS: Evidence was found that supports the general efficacy of three first-line smoking cessation interventions: counseling, bupropion-sustained release (BSR), and nicotine replacement therapy (NRT). What the evidence does not show, however, is which of these interventions may be more effective for women versus men in general or specifically in the 40- to 65-year-old age group. RECOMMENDATIONS: Recommendations include the development of a clinical trial and the inclusion from the outset of gender as a major variable in all future intervention studies. IMPLICATIONS: Practice implications include the fact that since effective treatments already exist for assisting clients to stop smoking, all health-care providers should offer an intervention that has been found effective to any client who expresses a desire to quit smoking. Further studies of efficacy are needed to develop more focused implications.

Using the "Seven A's" assessment tool for developing competency in case management.

In the latter part of the 20th century, healthcare reform sparked a transition in the nursing curriculum from acute care to primary and secondary care. Faculty responded to this challenge by redesigning curricula in creative ways. The transitional curriculum introduced community clinical experiences designed to challenge students to practice in diverse, nontraditional sites and in more independent ways. Such practice requires the nurse to function as designer, coordinator, and manager of patient care in addition to the traditional provider role. Additionally, the transitional curricula emphasized the roles of communicator, educator, facilitator, listener, and advocate to a greater degree. For students to achieve competence in the above roles, the curriculum must include learning activities that allow them to practice as case managers in the community. This paper presents the "Seven A's" as a framework for students to gain an understanding of and engage in the role and process of case management in the community.

Gender's effect on the efficacy of smoking cessation interventions.

Evidence-based guidelines and subsequent studies support the effectiveness of counselling and pharmacotherapy as first-line smoking cessation interventions. Gender is one of many factors that may have an impact on the efficacy of smoking cessation interventions. There is only very limited evidence, however, to answer the question of how gender influences the effectiveness of smoking cessation interventions. Research does suggest that concern about weight gain is related to women's confidence in their ability to stop smoking and this should be kept in mind when designing interventions. In the meantime, any client who indicates a desire to stop smoking should be offered one of the smoking cessation interventions that are already available.

Community support: older adults' perceptions.

The purpose of this inquiry was to determine older adults' perceptions of facilitators and barriers in their use of community support. A descriptive, exploratory design was used incorporating focus group methodology. Fifteen participants were recruited in two separate senior citizen housing complexes, 10 in one building and 5 in the second. All participants were 65 years of age and older, alert, oriented, and English speaking. Systematic content analysis of the focus groups revealed two general categories: knowledge and systems. Under each category, facilitators and barriers were identified. Knowledge facilitators included life experiences and learning from one another. A major knowledge barrier was lack of awareness. A system facilitator was caring connections. System barriers included complex connections, pseudoconnections, superficial connections, and cookie cutter connections. The data suggest the need for additional research to further clarify these facilitators and barriers. The information obtained from this research will be a beginning step in the development of supportive intervention strategies for assisting older adults as they live in their home communities.